Using yoga to relieve low back pain: what to do, what to avoid

When it comes to relieving chronic low back pain, very few traditional treatments—like pain killers, physical therapy, or surgery—provide significant relief. Thus, the National Institutes of Health has been throwing research dollars at less traditional therapies, like yoga, to see if they’re any better. One recent study funded by NIH’s National Center for Complementary and Alternative Medicine found that regular yoga practice improved function and reduced back pain symptoms better than routine medical care in 228 back pain sufferers who participated in a clinical trial.

But the researchers also found that those study participants who took regular stretching classes also experienced increased mobility and less pain—on par with those who took yoga.

“I was actually surprised that yoga worked,” said study author Karen Sherman, of the Group Health Research Institute in Seattle, during an online roundtable discussion on Monday. “But now we’re now trying to find out what’s going on. Was it the movement involved in the poses or the relaxation and stretches?”

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She pointed out that of the 100-plus treatments touted for back pain, most haven’t been tested in clinical trials, so it’s impossible for doctors to know whether they really work and for whom.

The “for whom” aspect is crucial. For example, the study comparing yoga and stretching with routine medical care excluded patients whose back pain was attributed to a specific cause like sciatica, spinal stenosis, a slipped disk, or fracturerd vertebra. Those who weren’t willing to practice yoga poses or stretching at home in between weekly classes were also excluded.

Thus, the patients in this study were highly motivated to engage in exercise and didn’t have back conditions severe enough to limit their movements, which means they probably received the maximum potential benefits from the therapy with a minimal risk of injury.

The study participants also had optimal yoga training with instructors well versed in back pain and able to modify poses based on their particular weak spots. The type of yoga practiced in the study was viniyoga, which emphasizes adaptation to individual students. “The ideal sequence of poses might differ from person to person,” explained Sherman.

For a person whose back pain is caused by tense, tight muscles, she said, relaxation poses like a type of back-bend called the wheel pose might be more useful. Those with weak muscles that can’t properly support their spine might need strengthening poses for their hip muscles.

Finding a yoga instructor properly trained in viniyoga is key if you’re taking yoga to relieve chronic pain. “Observe classes, ask other students for advice on who’s good, and speak to the instructor beforehand,” advised NCCAM director Dr. Josephine Briggs, an avid yoga practitioner who led the roundtable discussion. Your instructor should recommend ways to adapt poses based on your physical limitations.

You should also get a green light from your doctor since it may not be safe to practice yoga for specific conditions causing chronic pain. If your doctor can recommend a particular yoga instructor, that’s even better.